UR Manager

We are passionate about what we do and delight in providing excellent programs that make permanent, positive changes in the lives of those we serve. Our programs are designed to equip our clients with the vision, motivation, life skills, education, and self-discipline necessary to lead a successful life.

Program Overview

Located in Columbus, OH, Torii Behavioral provides treatment services to adolescents, ages 12 to 17, with mental health and behavioral disorders. We have a 20-bed acute hospital accredited by the Joint Commission for teens requiring intensive crisis care and treatment intervention.

Job Duties

Review medical records to determine appropriateness of admissions, procedures and necessity of continued hospital stay according to CMS guidelines.

    Initiate admission and concurrent medical record review on Medicare, Medicaid and private insurance beneficiaries.  Ensure all required admissions documents are obtained.

Identify patients requiring pre-admission and continued stay authorizations, in compliance with third party payer requirements, and obtains authorizations required for reimbursement.

    Review medical records on a continuing basis to identify the need for on-gong hospitalization.  Collaborates with all interdisciplinary staff to evaluate clinical data.

Ensure a timely review for all identified third party reimbursement cases. For billing and hospitalization utilization review purposes, the reviewer will identify and certify the acute hospital length of stay authorized for each case.

Initiate and maintain medical records for new patients in the electronic medical record program.

Contact for referral sources.
     
 Respond to requests for medical records and reports.

Coordinate orderly admission process for patients.

Collaborates with multi-disciplinary team members during discharge planning.

Act as the electronic medical record administrator.

Maintain compliancy with regulation changes affecting utilization management.

Position Requirements

 Bachelor’s degree required.

 Active RN License from an accredited nursing school

 Minimum three to five year’s related experience, preferably in the behavioral health field.

Benefits

DailyPay

Educational Assistance Program

Medical, Dental, and Vision benefits after sixty days

Company provided Basic Term Life, Long Term Disability and AD&D insurance

Flexible Spending Program/Health Savings Account

401(k) after sixty days

Paid Parental Leave